Healthcare Provider Details

I. General information

NPI: 1962733261
Provider Name (Legal Business Name): ANDREW DAVID CARSON P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2010
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1259 S PINELLAS AVE
TARPON SPRINGS FL
34689-3719
US

IV. Provider business mailing address

1259 S PINELLAS AVE
TARPON SPRINGS FL
34689-3719
US

V. Phone/Fax

Practice location:
  • Phone: 727-938-1908
  • Fax: 727-938-8693
Mailing address:
  • Phone: 727-938-1908
  • Fax: 727-938-8693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9105368
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: